HomeMy WebLinkAboutDrain Layers Permit 179 Natsisky Farm Ro TOWN OF. SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o. 4863
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform,,the work ind�cate.4 below at
y � ``'art
at premises owned b --,
' l��.r� % t 'v5✓�iv�/
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other .
Fam acres.
ily Units, with occupancy or use, with
.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES ( ), OR ( ) ( ), INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to �Zen1 ( UST!%(iC77 o,J 60,
the holder of Drain Layer's License No. Peit will after date of issuance. The undersigned Drain Layer hereby agrees xtor all htheyterms ands
conditions set forth in the permit and the reverse side thereof. Applicant has re ived
Town Permit No. and/or CHD Permit No. 2c7211;?191Z ,
Signed C
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in ,the name f the Town of South Windsor:
Eng neeri g Departme Da e
Connection Charge Paid
Permit Fee: Paid
Check Number
Issued by
Tax Office
i
r
INSPECTION
Date work started . / 9
Sufficient notification received: Date completed 7�
-11
Special Conditions No
APPROVED: fU n`7 _ Z/
Inspector ate